This is after the hepatitis C outbreak at Singapore General Hospital (SGH) - initially believed to have been caused by this type of medication. Of the 22 patients from Ward 67 who contracted hepatitis C, four have died from the infection. A fifth fatality is being investigated.

After investigations showed that one source could have been intravenous injectable agents, SGH stopped multi-dosing - a long-accepted practice - within the affected ward first and then throughout the hospital.

But other hospitals still use multi-dose vials.

Associate Professor Lew said medication in multi-dose vials is used constantly throughout TTSH.

"These are not available in single dose, and there are no alternatives based on current manufactured supply. Since there is no alternative, we will ensure the use is consistent with best practices... But we are reviewing our processes, looking at guidelines provided to ensure we are in compliance with best practices," he said.

"Of these, 13 are stored in multi-dose vials. Of the 13, eight are not commonly administered and so they are used on multi-patients. The rest are for single patients," he added.

CONTROL SYSTEM

In a statement to the media yesterday, National University Hospital (NUH) also said it has an infection control system in place and audit for compliance.

"As part of care management, our renal patients are routinely investigated for any symptomatic liver disease or abnormal liver function blood tests results. Based on the ongoing monitoring of our renal patients, we have not observed any unusual trends in HCV (hep C virus) infections," its spokesman said.

Reporters toured both SGH and TTSH yesterdayand were briefed on the Patient Safety and Infection Control measures.

Demonstrating how the hospital's Dialysis Centre was cleared, SGH nurses went through the safety procedures using a simulation room.

SGH chairman of medical board Fong Kok Yong said: "We have taken action to further tighten and ensure that (hepatitis C) would not spread further."

SGH has been contacting a total of 678 patients, who were admitted to Wards 64A and 67 from January to June and as at 6pm yesterday, it has contacted 646 patients. More than 580 have confirmed their appointments for screening.

To date, 186 patients and 202 out of 273 staff have been screened.

Questions have been raised on the time it took to inform the Ministry of Health and the public about the outbreak.

Prof Fong said: "I'd like the independent review committee to make a thorough investigation. We are fully cooperative, whatever they ask we have provided them and they have a free hand to look at whatever they need to look at."

Health Minister Gan Kim Yong said SGH has provided the sequence of events and the actions taken between April and August.

IMPORTANT

"This is an important area that the independent Review Committee will be looking into critically to determine whether there are gaps in the process, including the timeliness of SGH's response, how crucial information is reported, and whether there are areas that need to be tightened and improved upon, such as safety protocols and information flow," Mr Gan said late last night.

"If there are gaps, we will close them. If there are weak areas, we will correct them. And if there are shortcomings, we will improve."

He added that it is "important that we remain transparent" and assured the public that the findings of the Review Committee will be shared when they are ready.